Palmoplantar pustular psoriasis following initiation of a beta-blocker: disease control with low-dose methotrexate.

Palmoplantar pustular psoriasis is a debilitating chronic disease that can have a serious impact on patients' quality of life. There currently is no therapeutics standard for controlling palmoplantar pustular psoriasis, but various treatments, many of which have serious toxic side effects, have been used to treat this disease, including methotrexate. We report a case of palmoplantar pustular psoriasis in a 76-year-old woman that was triggered by initiation of a beta-blocker. The patient's condition was controlled with a low-dose regimen of methotrexate. It is important for dermatologists to recognize that pustular psoriasis can be treated with low-dose methotrexate to avoid potentially toxic effects of higher doses of methotrexate, which is especially true in cases of drug-induced disease, as seen in our patient.